LOGOTHERAPY AND COGNITIVE REFRAMING IN THE MANAGEMENT OF BLAME ATTRIBUTION AMONG NEWLY DIAGNOSED CANCER PATIENTS IN SOUTHWESTERN NIGERIA

Abstract

Blame attribution is a situation whereby patients apportion blame of the cause of their illness to themselves, the environment, significant others and illogical factors. The negative effects of this behaviour on newly diagnosed cancer patients include poor prognosis and management of the disease. Previous studies focused largely on psychological and social factors influencing blame attribution, with little emphasis on therapeutic interventions through the use of logotherapy and cognitive reframing. However, many newly diagnosed cancer patients in southwestern Nigeria are deficient in the management of blame attribution, which often results in emotional distress and failure to adhere to orthodox form of treatment. This study, therefore, was carried out to determine the effects of Logotherapy (LT) and Cognitive Reframing (CR) in the management of blame attribution among newly diagnosed cancer patients in southwestern Nigeria. The moderating effects of health self-efficacy and social support were also examined.

The study was anchored to the Health Belief Model, while the pretest-posttest control group quasi-experimental design with a 3x2x2 factorial matrix was adopted. Three states (Oyo, Lagos and Ogun) with cancer treatment centres (University College Hospital, Ibadan; Lagos University Teaching Hospital, Lagos and Federal Medical Centre, Abeokuta) respectively in southwestern Nigeria were purposively selected. The Blame Attribution Questionnaire (α=0.81) was used for screening. Fifty-four cancer patients who scored high on the Blame Attribution Screening tool were selected. The participants were randomly assigned to LT (18), CR (21) and control (15) groups. The instruments used were Modified Attributions for Illness (α=0.85), Health Self-Efficacy (α=0.84) and Medical Outcomes Survey Social Support (α=0.89) scales. Treatment lasted eight weeks. Data were analysed using descriptive statistics, Analysis of covariance and Scheffe post-hoc test at 0.05 level of significance.

Participants’ average age was 53.85±7.89 years and they were mostly females (88.9%). Types of cancer participants suffer from were breast cancer (53.7%), cervical cancer (33.3%), prostate cancer (9.3%) and skin cancer (3.7%). There was a significant main effect of treatment on blame attribution among the participants (F(2;42) = 16.03; partial = 0.43). The participants in the CR ( = 42.91) benefitted more than those in the LT ( = 63.56) and the control ( = 66.87) groups. There was a significant main effect of health self-efficacy (F(1;42 ) = 6.09; partial = 0.13) on blame attribution. The participants with high health self-efficacy had a lower post-mean score on blame attribution (43.22) compared to those with low health self-efficacy (69.67). There was a significant main effect of social support (F(1;42)= 24.77; partial = 0.37) on blame attribution. The participants with high social support ( = 43.65) benefitted more than those with low social support ( = 71.28). The two-way and three-way interaction effects were not significant.

Logotherapy and cognitive reframing were effective in managing blame attribution among newly diagnosed cancer patients in southwestern Nigeria with particular attention to health self-efficacy and social support. Counselling and clinical psychologists should adopt these therapies in managing blame attribution among newly diagnosed cancer patients.